Medical Plans
Choosing a medical health plan is not a simple straightforward process. On the economic side, different health plans provide different levels of coverage and depending on the coverage you choose or what you are eligible for, they will have different costs.
No one plan will cover all of your medical costs, but you need to know how much you will have to pay, and understand what your plan's limits are, since some plans have annual limits and some have lifetime limits on how much they will pay. In addition, on the personal side there are a number of things to be considered about the quality of care a plan will provide, which is a highly personal decision not driven by costs alone.
What About Costs?
All health plans will have at least two components. You will pay a basic premium (usually monthly) for your health insurance, plus, you will have other payments that are required, which can come in a couple of different shapes, either deductibles or co payments.
- A deductible is the amount you will have to pay before the medical plan takes over the paying. For example if your plan has a $500 annual deductible, you will have pay the first $500 of your medical bills before the health plan begins to pay.
- A copayment is a percentage (or a fixed dollar amount) that you will have to pay for a doctor's services. For example if your plan has a 20% copayment and the doctor visit costs $100, you would have to pay $20 every time you visit the doctor
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Personal Considerations Can Impact the Quality of Your Care
- Choice of doctor - if you already have a relationship with a doctor can you continue to use him or her? Some medical plans require you to use only doctors who work with them. Not being able to go to a doctor you feel comfortable with may make a different plan seem worthwhile.
- Specialists - if you have to see a specialist, does the plan require you use one of their own “in plan specialists” or can you choose your own? If you go to a specialist not “in plan”, will you have any level of coverage?
- Preexisting conditions - if you are changing health plans you need to understand how preexisting conditions are treated. Some plans will not cover preexisting conditions, or only provide coverage after a certain amount of time. (The Health Insurance Portability and Accountability Act requires insurers to provide coverage for pre-existing conditions if you are joining a new group plan through your employer and you were covered by a medical plan for the previous twelve months).
- Emergency care - you need to understand what the plan considers an “emergency”, since your definition of an emergency and the plan's may not be the same and you might not be covered.
- Regular physicals – does the plan cover annual physicals and health screenings? Some don't. Also does the plan provide for “well baby checkups” and immunizations?
- Pregnancy - how much will you have to pay out-of-pocket for pregnancy and birth care
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The above are just a few of the considerations you need to keep in mind when choosing a medical plan. Finding the right plan is not easy and it isn't fun. However, you owe it yourself and your family to invest enough time to make an educated choice.
By Murray Anderson
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